Dental and skeletal effects of two-piece and three-piece surgically assisted rapid maxillary expansion with complete mobilization: a retrospective cohort study.

PURPOSE: The aim of this study was to examine the dental and skeletal widening effects of 2 surgically assisted rapid maxillary expansion (SARME) techniques after complete mobilization of the maxilla in patients with transverse maxillary hypoplasia and bilateral crossbite. MATERIALS AND METHODS: A retrospective cohort study design was implemented evaluating 2 treatment groups with complete Le Fort I osteotomy and segmentation of the maxilla followed by distraction using a tooth-borne expansion device: patients without crowding of the incisor roots underwent 2-piece SARME and patients with crowding underwent 3-piece SARME. Linear transverse measurements were performed on dental casts (intercanine and inter-second molar distance) and posteroanterior cephalograms (skeletal jugulum distance) before surgery (T1) and at 6 weeks (T2), 6 months (T3), and 12 months (T4) postoperatively. RESULTS: The study included 24 patients (13 women and 11 men; mean age, 27 yr; standard deviation, 18.5 yr). Significant maxillary expansion was achieved by the 2 surgical techniques (P < .05), especially in the posterior portion. From T1 to T2, widening values (+3.8 mm) at the intercanine level in the 2-piece SARME group were significantly higher (P = .004) than those in the 3-piece SARME group. Distraction effects were mainly skeletal, whereas dental relapse tendencies predominated at T3 and T4. CONCLUSION: The 2 SARME methods ensured sufficient widening with satisfactory results after a 12-month period. To decrease surgical risks to the incisor roots and esthetic impairments, 3-piece SARME with complete mobilization is recommended in cases of transverse posterior maxillary hypoplasia and crowding of the incisor roots.

Orthodontic orthognathic surgical treatment of a subject with Williams Beuren syndrome a follow-up from 8 to 25 years of age.

This article presents a survey of characteristic features of Williams-Beuren syndrome (WBS) as reported in the literature and the interdisciplinary treatment of a subject with WBS with special regard to morphological and functional disorders. Typical features of a patient with WBS and his dental development in a follow-up from 8 to 25 years of age are shown. Early orthodontic treatment approaches, later combined orthodontic-orthognathic surgical procedures, and the status 5 years after surgery are presented.

High-resolution multislice computerized tomography with multiplanar and 3-dimensional reformation imaging in rapid palatal expansion.

INTRODUCTION: The purpose of this study was to evaluate whether high-resolution multislice computerized tomography (CT) with multiplanar reformation and 3-dimensional (3D) imaging is helpful in demonstrating the effects on midfacial sutures induced by rapid palatal expansion (RPE), thereby appraising and corroborating the current state of the art or possibly adding new findings. METHODS: Two patients in different stages of skeletal maturity (aged 10 and 16 years) underwent CT examinations immediately after active opening with the RPE appliance. RESULTS: The 3D CT imaging method proved to be valuable in visualizing skeletal effects on not only the midpalatal suture, but also adjacent sutures. It allowed precise 3D location of tooth positions. In the 3D CT images of 1 patient, the complete opening of the midpalatal suture was visible. The median dissection of the incisal foramen at the point of unification of the 2 nasopalatine channels could be visualized. Additionally, the positions of severely displaced maxillary canines could be located precisely. In the other patient, apart from the completely open midpalatal suture, the opening or widening of the internasal suture, the nasomaxillary sutures, and the frontomaxillary sutures were visible. CONCLUSIONS: The 3D imaging of high-resolution multislice CT opens up a new dimension in orofacial diagnosis. Improvements of the quantity and the exactness of diagnostic parameters were attained. The imaging method is helpful and indicated in RPE patients with additional diagnostic objectives related to the development of occlusion. This imaging method is recommended in borderline cases (juvenile or adult patients with questionable sutural response) to determine whether the suture is completely open or whether surgical support is needed.